Carotid artery angioplasty and use of stents in high-risk patients with contralateral occlusions

Object. The risks associated with carotid endarterectomy (CEA) are increase d in the presence of contralateral carotid artery (CA) occlusion. The 30-da y stroke and death rate for patients in the North American Symptomatic Caro tid Endarterectomy Trial (NASCET) who had contralateral CA occlusion was 14 .3%. The authors analyze their experience with angioplasty and/or stent pla cement in patients with contralateral CA occlusion to determine the safety and efficacy of endoluminal revascularization in this subgroup. Methods. Twenty-six procedures were evaluated in 23 patients with high-grad e CA stenosis and contralateral CA occlusion. The first 15 procedures were evaluated retrospectively, and the next 11 prospectively. All patients had severe medical cormobidities and were considered too high risk for CEA, eve n without considering the contralateral occlusion. Clinical follow-up revie w was performed an average of 18 months later (median 15 months). Conclusions. The average ipsilateral CA stenosis according to NASCET criter ia was 78% preprocedure and 5% postprocedure. There were no changes in neur ological or functional outcome immediately postoperatively in any patient. The 30-day postoperative stroke and death rates were zero. However, there w as one symptomatic femoral hematoma that resolved without surgery. At follo w up, there were three patients who had suffered stroke or death. One patie nt died secondary to respiratory arrest at 2 months; one died secondary to prostate carcinoma at 12 months: and one patient experienced a minor stroke contralateral to the treated artery at 41 months. Despite the substantial preoperative risk factors in patients in this series, the 30-day stroke and death rate for angioplasty and/or stent placement appears to be lower than that of CEA in patients with contralateral occlusions.